Reducing the Odds Preventing Perinatal Transmission of HIV in the United States (1999) / Chapter Skim
Currently Skimming:
5 Context of Services for Women and Children Affected by HIV/AIDS
5 Context of Services for Women and Children Affected by HIV/AIDS
Pages 54-67
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 54... ...
The chapter analyzes current trends in health care and social services to determine how they may affect access to services important for reducing the risk of perinatal HIV transmission and treating those already 54
|
From page 55... ...
so c)
|
From page 56... ...
Some women and children are not served by private providers because they do not have health insurance, there are no private providers locally, or those available do not accept public insurance. These women and children rely on a variety of public and private, nonprofit facilities, often referred to as "the safety net." These facilities include clinics operated by state or local health departments, community or migrant health centers, public and private, nonprofit hospitals, and family planning clinics operated by Planned Parenthood affiliates and other private nonprofit groups.
|
From page 57... ...
These include HIV testing and counseling centers, community-based nonprofit AIDS service organizations, and clinic settings. FINANCING HEALTH CARE SERVICES FOR WOMEN, CHILDREN, AND ADOLESCENTS Health care for women of reproductive age and for children is financed by private and public insurance and by a wide range of other funding mechanisms that support community-based public and not-for-profit agencies.
|
From page 58... ...
Private health insurance on an individual basis is much more expensive, and the percentage of women and children with private insurance has declined steadily over the past decade (EB RI, 1997~. A number of issues about private insurance coverage for HIV/AIDS remain unresolved at this time.
|
From page 59... ...
In 1996 only 15% of women in care for HIV with an asymptomatic HIV diagnosis (CD4 count of 500 or above) had private insurance, 60% had public insurance (Medicaid and Medicare)
|
From page 60... ...
State funding consists of matching contributions required by specific programs, shared funding, or supplemental funds used to expand service support. Local health agencies, especially ones serving large populations, may also fund primary and secondary health services.
|
From page 61... ...
Under the Ryan White CARE Act, funds are awarded to eligible metropolitan areas under Title I to provide outpatient health care, support services, and inpatient case management. Title II funds go to states for home- and communitybased health care and support services, continuation of health insurance coverage, and drug treatment through the AIDS Drug Assistance Program (ADAP)
|
From page 62... ...
Private providers are responsible to licensing boards, must follow Medicaid requirements if Medicaid-certified, must consider the recommendations of their professional organization regarding standards of care if they are to avoid litigation, and must respond to the standards of the hospitals or managed care organizations with which they are affiliated. State and local public and private, nonprofit agencies frequently have multiple sources of funds and must meet the requirements established by each of these funders, as well as state and local governing bodies and boards.
|
From page 63... ...
This shift has increased the variability that has always existed from community to community in the organization, structure, and funding of health care services, creating important challenges to mounting an effective effort to reduce HIV perinatal transmission. Implementation of the committee's recommendations will require changes in the policies developed by federal, state, and local government groups, managed care organizations, and professional groups, as well as broad dissemination of those policies.
|
From page 64... ...
have dropped precipitously among households headed by non-citizens, even though many non-citizens and/or their children remain eligible (Lewis et al., 19981. Another potential problem is that even though transitional Medicaid is maintained under welfare reform, many women who move from welfare to work may eventually secure employment that places them above Medicaid income eligibility cut-offs, but do not provide private insurance.
|
From page 65... ...
For example, relationships have to be built between the MCOs and the type of providers that adolescents seek teen clinics, school health clinics, community family practice sites, and family planning clinics. Some of the problems encountered by persons with HIV enrolled in MCOs include reduced access to specialty care providers, including HIV specialists; reduced access to specific drug formularies and specific services; clinical decisions apparently made on the basis of cost; limitations placed on the information providers can provide; and insufficient time with providers.
|
From page 66... ...
Managed care contracts, like traditional insurance contracts, do not typically identify specific conditions, and services are limited to what the purchaser specifies. In 1996, 18 states covered counseling and testing for HIV in their Medicaid managed care contracts, usually in the context of family planning services only.
|
From page 67... ...
The complex patterns of sources of medical care, financing mechanisms, program authorities, and organizations that influence care make it difficult to institute policies for reducing perinatal HIV transmission. Local, state, and federal agencies have made many efforts to inform providers and the public, and to promote counseling and testing of pregnant women wherever services are offered, especially in states and communities with a high incidence of HIV infection.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.